NPI | 1740552249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: MI 4301111208) |
Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: AZ 78132) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-01-31 |
Last Update Date | 2025-08-15 |